Follicular Occlusion Syndrome — a Possible Option of Follicular-Retension Origin of Pilonidal Sinus

Аim: to analyze and evaluate the clinical and morphological manifestations of pilonidal sinus disease (PSD) as a part of follicular occlusion syndrome (FOS).Materials and methods. In the Clinic of Coloproctology and Minimally Invasive Surgery, 80 patients with PSD underwent surgeries from November 2018 to December 2019: 62 (77.5 %) patients — with primary PSD, 18 (22.5 %) — with recurrence of the disease.Results. There were 80 patients, 6 patients (9.7 %) with primary and one (5.6 %) patient with recurrent cyst had concomitant manifestations of follicular occlusion syndrome. Thus, the frequency of combination of PSD with other variants of FOS course amounted to 8.8 %. Hidradenitis suppurativa of axillary and inguinal areas was found in 5 out of 7 patients. Acne conglobata, as one of the components of FOS, was noted in three patients. Dissecting cellulitis of the scalp was diagnosed in one patient. Follicular occlusion triad was observed in two patients. Follicular occlusion tetrad was not noted in any observation. All patients were treated with excision of the pilonidal sinus disease with local tissue-plasty of the defect. At present, no recurrences have been noted in any of the cases, and the mean follow-up time was 14 ± 5.6 months (6–27 months). PSD as a manifestation of follicular occlusion syndrome is characterized by a more cranial and more superficial location of the cavity in the sacrococcygeal region. According to the data of histologic examination of patients with FOS, the morphologic picture is identical with patients with isolated PSD. All patients with confirmed FOS have received pathogenetic local and conservative therapy. After the therapy remission of combined diseases is noted.Conclusion. Deroofing of the lining of the cavity, often used in dermatologic practice, along with complex treatment within the framework of multidisciplinary (together with a dermatologist) management of patients with FOS, looks promising

Clinical Recommendations of the Russian Scientific Liver Society and Russian Gastroenterological Association on Diagnosis and Treatment of Liver Fibrosis, Cirrhosis and Their Complications

Aim. Current clinical recommendations are intended to supply gastroenterologists, physicians and general practitioners with modern methods for the diagnosis and treatment of liver cirrhosis and fibrosis.Key points. Liver fibrosis develops with connective tissue accumulation in liver in the outcome of various chronic diseases, including alcohol misuse, viral hepatitises, autoimmune and more rare hereditary liver diseases. Liver cirrhosis is the final stage of most chronic diffuse liver diseases. The recommendations present current opinions on pathogenesis of liver fibrosis and cirrhosis, principles of diagnosis, treatment and prevention of their main complications: hepatic encephalopathy, oesophageal and gastric variceal bleeding, acute kidney injury/hepatorenal syndrome, infectious complications (i.a. spontaneous bacterial peritonitis), hyponatraemia, pulmonary complications, etc.Conclusion. Timely diagnosis and adequate therapy in cirrhosis can prevent life-threatening complications and improve the patients’ prognosis and quality of life

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Розумні дороги, як основа ресурсозберігаючих технологій у транспортній інфраструктурі

Reasoning from the quality of roads, one may draw a conclusion as to the level of the state economic development. Nowadays there appear new generation roads, so-called «Smart Roads». «Smart Roads» must by themselves ensure power supply and road markings depending on traffic conditions; they must glow in the darkness, warn drivers of potentially dangerous road sections, monitor traffic conditions, react to emerging problems, charge electric vehicles in motion, etc. Therefore they must be equipped with a complex of the latest achievements in the fields of science and technology. The article proposes the design of the «Smart Roads» system panels, describes its operation principle and functionality. In the article, road paving panels for «Smart Roads» system have been calculated with an analysis of the amount of generated and consumed electric energy. This system is completely self-sufficient, i.e., it acts as an alternative and decentralized source of energy. In the daytime, solar energy from the solar panels is accumulated in the batteries by the side of the road. Also, energy comes from the piezoelectric elements when a car moves on the panel. When it gets dark, the accumulated energy is expended on the operation of the panel itself and on the LEDs that draw road markings and highlight certain parts of the road (if necessary). Excess electrical energy is supplied to other consumers of electricity. The amount of electricity generated per unit of road surface has been calculated. It is shown that for their own needs road paving panels will consume up to 71,25% of the total energy generatedПроведена разработка и расчет панелей дорожного покрытия для системы «Умная дорога» с анализом количества сгенерированной и потребленной электроэнергии. Представлено конструктивное исполнение и раскрыт принцип действия системы «Умная дорога». Проведен расчет количества сгенерированной электроэнергии на единицу площади дорожного покрытия. Показано, что для обеспечения собственных нужд дорожные панели будут использовать до 71,25% от общего количества сгенерированной энергииПроведено розробку і розрахунок панелей дорожнього покриття для системи «Розумна дорога» з аналізом кількості згенерованої і споживаної електроенергії. Представлено конструктивне виконання і розкрито принцип дії системи «Розумна дорога». Проведено розрахунок кількості згенерованої електроенергії на одиницю площі дорожнього покриття. Показано, що для забезпечення власних потреб дорожні панелі будуть використовувати до 71,25% від загальної кількості енергії, що згенерован

The short-term and long-term results of three-stage surgical treatment of ulcerative colitis with formation of ileal J-pouch

Aim of investigation. To estimate results of three- stage treatment approach in severe ulcerative colitis aimed for resection of affected colon and restoration of intestinal continuity. Material and methods. Overall 22 patients were treated according to the three-stage mode, of them 20 were operated urgently due to development of acute complications. The average duration of conservative treatment was 32,8±42,5 months. All patients at the first stage underwent operations related to the emergency state, at the second stage - reconstructive surgery with formation of the ileal J-pouch followed by closure of ileostoma. Results. Patients, who underwent the first stage of treatment on the basis of our institution, had shorter time of surgical treatment, as compared to the cases when colectomy was performed in the other clinics: 4,7±1,6 and 46,1±39,8 months respectively (p=0,02). The average work capacity recovery after surgical treatment was 4±2 months. Stool frequency was 6,1±2,45 times per day, every fifth patient had nighttime defecation; 19 of 21 patients could distinguish type of their reservoir contents and were able to provide its retention. Pouchitis was observed in 21% of cases. The pouch malfunction requiring its resection occurred in 4%. Conclusions. The three-stage surgery for ulcerative colitis is an optimum management approach in the presence of complicated ulcerative colitis. It allows to carry out colonic resection with the lowest risk of morbidity, to create the intestinal reservoir , to provide social professional rehabilitation of patients and to reduce postoperative complications rate significantly. Key words: ulcerative colitis, ileal pouch, colectomy, proctectomy, laparoscop